‘I Asked The Doctor To Tell Me Everything Patients Usually Do Wrong During Telemed Appointments'
“Rocco! Here, Rocco! Shhh!”
Kerri Masutto smiles and then leans down to give her dog a treat. “I’ve had the bone in my lap just in case he started barking,” she tells me.
I’m thisclose to asking her to point her computer screen toward her pup so Rocco can join our Zoom call (what can I say? I love dogs), but before I have a chance to ask, Masutto finishes her thought. “So, I would definitely recommend a baseline dose of vitamin D every day until you have blood work done to see exactly where your level is at.”
In some ways, it feels like Masutto and I are having the kind of Zoom catchup I have with friends and co-workers all the time right now. Except this virtual check-in is actually a check-up: Dr. Kerri Masutto, MD, is an internal medicine primary care physician with Parsley Health, a medical practice that offers both in-person visits and virtual appointments over video chat—like the one we’re having now.
If it seems like everyone is embracing telehealth more than ever before, it’s because we are. The Cleveland Clinic logged more than 60,000 telemedicine visits in March 2020, compared to the 3,400 virtual visits they typically average. Meanwhile, health-tech companies like Teladoc, Doctor On Demand, and Amwell have all reported increases of about 50 percent more virtual doc visits now than before the novel coronavirus outbreak. And Parsley Health told me they had a 70 percent boost in business from January to March 2020 compared to the same time period in 2019.
Curious about the trend, I scheduled a checkup with Dr. Masutto to find out for myself what telemed is all about. Here’s what I learned about how to get the most out of a virtual doc visit.
1. Use the online paperwork to flag immediate problems—and give the doc a big-picture POV of your health.
I spent 15 minutes clicking through Parsley’s “health goals” and “symptom tracker” questionnaires before my appointment. Annoying? A little. But no more so than the old-school clipboard of paperwork a receptionist might hand you—and definitely less germ-y than the iPads higher-tech offices use, which who-knows-how-many hands have touched (and who knows how well they’ve been disinfected).
Rather than speed-clicking my way through these questions, I settled in and really thought about them—even putting in questions about stuff I’ve wondered about for a while, like why my PMS seems to be getting worse as I get older and if I need a vitamin D supplement.
Dr. Masutto gives me kudos for this strategy. “Even if the reason you scheduled the appointment was to talk about something specific—like a cough or a UTI—bringing up other concerns you have can help give your doctor a bigger picture of your overall health,” she tells me. “And those intake forms are a great way to jog your memory, so you remember to mention that other stuff during your appointment.”
2. Check security protocols—and that this doc can legally examine you virtually—before your appointment.
Dr. Masutto is already in our Zoom meeting room on Parsley’s private portal when I log in, and after a quick hello she asks to see my driver’s license to confirm I am who I say I am. She also asks me what city and state I’m currently in. This isn’t just get-to-know-you chit chat: Telemedicine law requires that you physically be in a state in which your doctor is licensed to practice for your first appointment. (In fact, some states require you to see a doc in person for your first visit, and then you can do virtual follow-up appointments.)
After that initial visit, your doc can treat you no matter where you are, though she may not be able to prescribe medication at a pharmacy that’s not in a state in which she’s licensed to practice.
Now that we’re in the middle of a global pandemic and more patients need to be seen virtually than ever before, many of these telemedicine laws are changing, says Dr. Robert Segal, MD, a New York City-based cardiologist at Medical Offices of Manhattan, which offers telehealth appointments.
“When you call to schedule your appointment, make sure the doctor’s office you’re working with knows where you live and can assure you that your physician will be able to treat you and prescribe medications if necessary.”
Also important: Confirm the platform you’re using for your virtual appointment is HIPAA-compliant, which includes a host of security requirements to ensure your privacy and safety. “The doctor’s office should really be doing their due diligence to make sure what they’re providing to patients is secure, but it doesn’t hurt to ask,” says Dr. Segal.
This feels a little over-the-top when I first hear it. After all, the kind of run-of-the-mill health woes I’ll talk about with Dr. Masutto don’t need supreme secrecy. Then I read this study, which found that cyber attacks against healthcare providers are on the rise. (In fact, medical identity theft has become a big thing, with security experts estimating your medical information is worth about 10 times more than your credit card number on the black market.) So, I go ahead and confirm with Dr. Masutto that we’re in a Zoom “room” that can’t be hacked.
3. Have a backup plan in place in the event of tech failures.
With the basics behind us, Dr. Masutto asks me why I’ve scheduled today’s appointment—and just as I launch into what’s “up” for me, her face freezes and I get a “Your internet bandwidth is poor” message in the middle of my laptop screen. I’m instantly annoyed and wonder how much time we’ll waste trying to figure out a solution. Then, Dr. Masutto calls my cell and we mute the sound on our video so we can still see each other and keep the appointment on track if internet issues freeze us again.
“You definitely want to work with a telemedicine company that doesn’t rely on communication through just one portal, because technical difficulties are bound to happen—especially right now, when everyone is using the internet more than usual,” she says.
When you book your appointment, ask what the protocol is if you have a connection issue and make sure there’s a HIPAA-compliant backup in place. You can also ask your doctor at the beginning of your appointment what you should do if the internet gets wonky and you get cut off, says Dr. Masutto.
4. Think of your first appointment as an interview for a doc who’ll work for you.
If you’re seeing a new doctor virtually right now because you’ve got a pressing health concern, use the appointment to handle that—and to gauge if you like the physician, says Dr. Renee Dua, MD, chief medical officer of telemedicine company Heal. “Finding a doctor who feels like the right fit is more important than many people think,” she says. “You want to find someone you can build a relationship with—someone you can talk to about your deepest, darkest concerns.”
Dr. Masutto agrees. “With telemed, it’s so much easier to try different doctors because you don’t have to carve out half a day to go into an office to meet someone,” she says. In fact, Dr. Masutto tells me to think of our first appointment a little like a first date: In the back of my mind, I should be thinking about what I’m looking for in a doctor, if I like the person's communication style, and if the vibe between us feels good.
“You could even ask your doctor things like, ‘Why did you go into medicine?’ Or, ‘What do you specialize in?’" says Dr. Masutto. "I think a great doctor might also say to you, ‘You know, I have a colleague who’d be a better fit for you because she specializes in autoimmune disease.’ You want someone who’s more concerned about being the right doctor for you versus just taking you on as a patient.”
If you’re seeing your go-to physician, your virtual appointment may feel a little strange at first—but try to keep an open mind, says Dr. Masutto. “The first few minutes your appointment may feel really different than usual,” she says. “But there’s a good chance you’ll adjust quickly and notice that your doctor can still cover almost everything she’d do at an in-person appointment.”
5. Get real with the doc about everything that’s going on for you, not just your most pressing symptoms.
Telemed appointments tend to be a little longer than in-person visits (anywhere from 20 minutes for something acute to an hour for an annual appointment), which means you can—and should—use the entire time you’re allotted and bring up all the things you’re worried about, says Dr. Dua.
“It isn’t just important for me to figure out if you have COVID-19 symptoms, for example, or something like a sinus infection or UTI,” she says. “I also want to know if you’re mentally struggling right now, or if your baby is overdue for a checkup or vaccination and you’re freaking out.” You might not think these secondary concerns are important, but they’ll help your doctor come up with a plan that’ll help you take care of you and your family—and put your mind at ease.
The bonus of bringing up this seemingly non-urgent stuff is that it can also help you build rapport with your doctor, says Dr. Masutto. “In an ideal world, you’d have an established relationship with a doctor who does telemed before a time of crisis, so you can quickly get the advice and support you need when you’re already in a stressed situation,” she says. “But you can still develop that relationship now, even if it has to be on Zoom.”
6. Be prepared for a virtual physical exam.
During my appointment, Dr. Masutto asks me to get a little closer to my computer screen and run my fingers down my neck, from my jawline to my clavicle bones. She asks if I feel any lumps, and tells me she’d actually be able to see if my lymph nodes were swollen.
If I had a sore throat, she says she might ask me to turn on the flashlight on my phone and shine it into my mouth so she could see my tonsils. As for a concerning skin rash or bug bite? She could take a look at that in real-time, too, though she also shares a tip: For anything physical that can show up on a photo, take a few shots from a few different angles in good, natural light and send those through the doctor’s secure messaging system before your appointment.
“Just remember that while we can do the vast majority of an exam via telemed, there will be times when a doctor might say, ‘I’m sorry, I think you need to be seen by a doctor in person,'" says Dr. Masutto. "You want to trust that your telemed doctor will let you know that if it’s necessary.”
If the doctor you see in person is different, ask them to send your visit notes to your telemed doc. “If I send my patient to an urgent care doctor, I like to see the visit notes so I can help my patient explain what he or she found and make sure it fits in our overall plan,” Dr. Masutto says.
7. Ask your doc to send you her notes after your appointment.
As my appointment with Dr. Masutto winds down, I’m blown away by how much ground we’ve covered. I’ve been taking notes as she fired off lifestyle and supplement suggestions for me, and it’s almost as if she can tell I’m craving a re-cap when she says, “You’ll get a message with my notes on everything we discussed, and I’ll recommend the exact supplements I like to make life easier for you.”
While most telehealth platforms will share notes automatically, feel free to ask for them, says Dr. Dua. Just be sure you get them through the doctor’s private portal—not via e-mail. “You want to make sure the telemed office is being careful with patient information, which means receiving notes in a HIPAA-compliant way,” says Dr. Dua.
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